Lida Paez, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN014786 Issued in GA

Practice address

3970 Five Forks Trickum Rd SW
Suite B
Lilburn, GA 30047-2339

Phone

(770) 921-8442

NPI assigned

Jul 20, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Dental Alliance of Lilburn, LLC

  • General Practice Dentistry
  • Lilburn, GA
  • NPI 1710544960
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405814400000",
    "number": "1194132308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 PARKLAND DR NE",
            "address_2": "UNIT 118",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303243589",
            "telephone_number": "678-641-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE B",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472339",
            "telephone_number": "770-921-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAEZ",
        "first_name": "LIDA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-20",
        "last_updated": "2014-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN014786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Optimum Health Management Corporation
• Optimus Hospitality
• Tanyetta Nicole Osborne
• Abosede A Oshinubi, RD, LD
• Outreach Pharmacy LLC
• Paige M Black DC, LLP
• Pain Spine MD LLC
• Tessica Paisley
• Jorge Alejandro Paladines, D.M.D.
• Quovadis Pallord, RBT

• General Practice Dentistry in Lilburn, GA
• Providers in Lilburn, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.